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So I inherited dad a few weeks ago when my brother and sister in law gave up. He's been declining physically and mentally (nearly 93). I WANT to take him to a nice assisted living or memory care place but with Covid, I don't feel it's the right thing to do just now. So I'm kind of stuck just dealing as best as I can. I am going to try to get someone in to give me a break a few days a week. He will balk at that. I was the one honest kid (of 3) who said "no way was he living with me" back when this all became an issue about a year and a half ago. We live in a different state so my tasks recently are just finding him new doctors and getting my head around all his needs which are considerable. Luckily he is still mobile and can dress himself but he is weak from heart and lung issues. He has moderate dementia and has been declared "unable to make informed choice"... yet he can have really interesting conversations at times. Still teases and jokes although his delivery is off since it's hard for him to find words. There has been no risk of wandering (he can barely walk from room to room). I know that Covid restrictions are not lifting anytime soon but what do I look for... memory care or assisted living? If assisted living, he really needs someone looking out for him because he will forget a meal, lose his hearing aids, forget how to adjust his hearing aids, etc. Obviously, he's best cared for here but I can only do this through covid because (why not, I'm stuck home anyway?). I guess I'm selfish but my husband also feels this way and it's his home too. And frankly my dad was always a very selfish guy himself. Please don't judge me. I want the best I can find for him, I just don't know what "label" of care to look for.

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Sounds like Assisted Living, since he is mobile and doesn't wander off.
What frustrates me about all the places, they rarely have photos of the rooms and facility on their websites! They want you to visit in person so that they can make a hard sell. BUT...covid!

The normal process is for his doctor to fill out the paperwork indicating he needs to go to AL, MC or NH. Then, whenever you find a place that is suitable, a rep from there will come to meet and evaluate your father to determine the level of care he needs.

Most assisted living facilities will accept a resident who can transfer from a wheelchair to another chair or to the bed with little or no assistance. From what you describe, he sounds like a perfect candidate for AL. Keep in mind that if he were to become combative or wander off, he would be sent elsewhere.

Oh, I don't know if it is STILL the case, but MC and NH were tax deductible as medical expenses. AL is not.
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No one here will think you are selfish and I honestly don't know anyone here who will recommend you try inhome care, even if they do it themselves. This is a grueling task, and all in the household must be totally on board. I never for a second thought I could do in home care, and I am a nurse. Trust me. No judgement.
Now, as to needs and such you are in a good position to begin looking now. I am assuming you are his POA? As he is judged unable to make decisions? If not it is too late for POA and you are looking likely at a temporary guardianship or conservatorship. It is likely to be uncontested, but will still not be without cost.
Step two is exploring the options. They will be unique to where you live, his assets, and etc. There are many organizations such as A Place for Mom (paid by the facility if you choose it) who will take you around free of cost. They will ask you his abilities, his assets, and his likes and dislikes. Do know that Board and Care is likely much less expensive in most areas and often nicer with only 5 to 7 residents with each having own room and eating communally. Assisted Living goes according to the room rental BUT then you have the care levels. He would need a higher one but not very high. Meds given, rooms cleaned, laundry, assist. If needing assist with bathing and other activities of daily living (ADLs) then it goes up and up and can get to 1,000 to 2,000 more a month before you need it. Some have apartments and some have cottages. Your best way to know what is out there is to be honest. Many now will have virtual tours. Tell them what you told us, and look around. So step one, what are his finances and who will handle them for him. Step two finding what living space works for him and can he afford it, or does he need application for medicaid and so on.
Wishing you good luck. You are starting on an EXTREMELY difficult journey at BEST , and that is even WITHOUT his living with you.
Stick around and read here. I came here in desperation, learned so much. And welcome.
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I am his financial power of attorney but his youngest sister is his medical power of attorney. I found the perfect 10person board and care for him but she was not on board with it. However, she is coming round to understanding that I can only do this through Covid and then he must find someplace new. And that she must get on board with me or likely end up caring for him herself (not going to happen). I wasn't ready to send him to the 10person board and care quite yet because I was in the middle of getting new docs, and getting his new life here in my state going. And I need time to assess. Unfortunately the 10person board and care place turned us down because they saw my aunt wasn't on board. Well, anyway, as far as I'm concerned, money isn't an object. He would say he won't pay a dime (and in fact won't pay us much to live here), but since I'm in charge of his money, I know he has enough to get into a nice place. I just don't want to do it until I can visit him easily.. maybe take him home now and then for a meal... you know, the way things used to be. In the meantime, I'm going to visit places and do research. I just didn't know what to "call" the kind of care he is needing. So thank you!
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The facility will do an assessment to determine the level of care dad needs.
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The facility will do an assessment before he moves in to determine if he is a good fit and that they can meet his needs. They are very good at this and will be honest with you. When I was looking for assisted living, I focused on facilties that offered activities he would like. For my dad, that was church and I made sure they could get him there (as it was, their bus when to HIS church so it was a no-brainer). Different facilties have different rules about things. I visited one that allowed no one to eat meals in their rooms. Then they said other things that put up flags for me that made me think they were very strict and my dad, being very stubborn, would not have done well there. My dad was in assisted living using a walker until covid but when they confined him to his room, he grew weak and is now in a wheelchair at skilled nursing because he developed continual cellulitis in his legs. We tried to move him to 2 different memory cares but he was still a 2 person transfer and neither facility would take him. Things have leveled out but the infections continue. We're thinking about possibly moving him to adult foster care but they are indicating another move might not be good for him at age 94.
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I would suggest AL bc of him being mobile and not a wander risk.

Regardless, of the big talk, MC agitates most residents. It's a locked
unit and designed in a circle.
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Isthisrealyreal Sep 2020
Not all of them are designed in a circular pattern.

Where someone is placed is determined by a needs assessment. There is no choice sometimes.
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I would put him in a board and care place.

I would also make it clear to his sister that she has no choice, he goes into a facility or she takes him right now. Interference that keeps him at your house will not be tolerated.

I am so angry on your behalf that she thinks she can force you to keep him. I would be dropping him off and let her deal with her decisions, but that's just my opinion.

I would also check the state laws governing medical power of attorney, I don't think that it gives her a vote on residence.

Don't feel bad about finding him a place to live where professionals can care for him. His life choices came with consequences and now he gets to reap what he has sown. Being POA means that you will still be helping him and advocating for him, it isn't like you are just walking away.

Best of luck.
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AlvaDeer Sep 2020
I so agree that Board and Care is often a good option and is often overlooked. I know several people who used then for elder's latter years. The care was wonderful, the community small (not more than 7 patients in these cases) and the care was personal, the patients more or less became family in a nice home. I don't say it is for everyone, but it is often less costly and often overlooked.
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Memory Care. They pretty much offer the same things assisted living does (if he can do something himself, he can), but they emphasize the mental and social stimulation which keeps them from declining mentally.

I've found that MC is independent living, assisted living, and skilled nursing all rolled into one. I don't have to worry about moving my mother as she declines and needs more care because her memory care place does everything all those places do.
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do you memory care at an assisted living facility?.................I'm new to caregiving too............my mom has vascular dementia, incontinence and is bedridden................I've been through the horrible overprescribed SNF stuff..........then assisted living with an enhanced license............felt mom was nearing the end and hated the assisted living place..........said frequently ignored by help...........couldn't feed herself and needs help with ADL...........so I took her home as I felt it was nearing the end...........wanted her to be comfortable................hospice got her a hospital bed, and nurses..............but I'll probably need to hire extra help with all the cleaning, positioning her in bed, etc................some assisted living places (not my mom's place) had a lot of activities the director said...........but didn't think my mom would/could participate in all that..............more I thought for more able bodied people who were able to engage in activities if offered.............my mom being bedridden, incontinent, vascular dementia was eating poorly there, a lot of waiting around............thought I'd like to be with her as who knows but think we're in a late stage.............I could try to feed her a bit myself..........she could tell me when her knees ached and I could bring her an analgesic........................very difficult situation with aging parents who require assistance...................it depends how active and with it they are..............I felt my mom wasn't get much more than incontinence clean up at assisted living, and with the pandemic restrictions, I could only see her through the window..............really felt she was declining...........when they handed me the labs some doctor ordered from assisted living, I found very abnormal results............the lab left voice messages..........three, for the doctor and he never called back..........I tried to locate him but couldn't............ended up taking mom to the ER where she was hospitalized for a few days, and discharged on hospice...............again, I will say, they have been very helpful..........but I will probably have to look for extra home health aides.............with helping with the incontinence, positioning in bed, etc.............I wish you the very best and hope that things turn out well..............these decisions can be agonizing to make.............they were for me, and inappropriately when my mom was hospitalized for a UTI they transferred her to Rehab at a SNF..........totally inappropriate.............I wanted hospice/palliative care but the palliative care nurse apologized for not being able to do a complete evaluation..........so denied hospice at that time..............rehab?...........overprescribed and isolated because of the pandemic...............a terrible situation...........they kept saying they're working with her and she's improving..............unrealistic goals...........I don't see where she improved and again, I think the goal of the SNF was highly inappropriate and unrealistic.........and they didn't listen to what the family wanted...................an awful time of my life knowing that she was there and hard dealing with a lot of the staff over the phone.............agonizing
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